Job Description

This is a Stanford Health Care - University Healthcare Alliance job.

A Brief Overview
A Physician Educator (Professional Billing Coding and Documentation Educator) provides training and education on proper documentation and coding practices, ensuring compliance with regulations and standards. They play a vital role in healthcare settings by educating providers and clinicians, reviewing coding accuracy, and staying updated on evolving guidelines.

The responsibilities consist of evaluation of the adequacy and accuracy of documentation in support of services billed, including ICD-10, CPT/HCPCS and other third-party payer codes, the medical necessity of services provided, and the compliance with other documentation, coding and billing standards. This position provides training, consultation, review and feedback to clinicians on their medical service documentation and coding to ensure that SMP clinics receive appropriate reimbursement and conforms to applicable guidelines and regulations.

Locations
Stanford Health Care - University Healthcare Alliance

What you will do

• Physician Education
• Training and Education: Conducting training sessions for physicians, staff, and other providers on coding and clinical documentation guidelines.
• Quality Assurance: Performing coding quality reviews, analyzing findings, and providing feedback to improve accuracy and compliance.
• Staying Current: Keeping up to date with the latest coding guidelines, regulations, and industry best practices.
• Documentation Review: Analyzing medical records to ensure accurate and complete documentation for billing purposes.
• Communication: Effectively communicating complex coding and billing information to diverse audiences.
• Collaboration: Working with various stakeholders, including physicians, coders, billers, and other healthcare professionals.
• Provide education to new providers and clinicians during their on-boarding period. This is a collaboration with SHC Office of Compliance and Privacy.
• Provides support to new and existing SMP sites by providing in clinic support to staff and Physicians to ensure compliant coding and documentation and use of Epic EMR.
• Provides on-site specialty specific training to individuals or groups of clinicians regarding documentation of services and appropriate coding of level of service, diagnoses, and procedures; including tips and techniques to help clinicians work more efficiently in Epic.
• Education and Specialty Workshops
• Performs requested clinical coding reviews to ensure accuracy of medical coding and documentation. Ensures that the clinicians use clinical expertise and judgment to determine correct coding & billing.
• Creates and publishes monthly Coding Corner Newsletter through the organization’s communication structure.
• Creates and educates through specialty workshops, in collaboration with medical group clinicians.
• Risk Adjustment Education
• Educates and guides healthcare providers and staff on accurate clinical documentation and coding practices, particularly concerning Hierarchical Condition Categories (HCCs) and risk adjustment methodologies.
• Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses.
• Evaluating medical records to verify that documentation meets industry standard criteria (i.e., M.E.A.T.) to support the submitted diagnosis codes.
• Providing feedback and education to providers on coding review findings and documentation improvement.
• Developing and delivering training materials on risk adjustment coding and documentation best practices.
• Collaborating with other departments to address coding updates and support risk adjustment programs.
• Compliance
• This is a collaboration with SHC Office of Compliance and Privacy.
• Assist with the implementation of emerging coding and compliance laws and regulations and assist with implementing privacy policies. Development and implementation of coding education.
• Maintain current knowledge of coding guidelines by conducting research, reading professional publications, and maintaining professional networks. Attending coding seminars, webinars and medical organization meetings.
• All other duties as assigned including department-specific functions and responsibilities:
• Performs other duties as assigned and participates in organization projects as assigned.
• Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

Education Qualifications

• High School equivalent or GED.
• Bachelor's degree preferred.

Experience Qualifications

• Four (4) years of work experience in a healthcare setting with demonstrated knowledge and of regulatory billing and coding guidelines and risk adjustment regulatory guidelines.
• Five (5) years of experience with multi-specialty physician coding within an EMR preferred.

Required Knowledge, Skills and Abilities

• Knowledge of CPT, HCPCS and ICD-10 codes and rules.
• Ability to analyze and develop solutions to complex problems.
• Ability to perform research regarding complex coding and regulatory guidelines.
• Ability to work effectively both as a team player and leader.
• Ability to apply judgment and make informed decisions.
• Ability to foster effective working relationships and build consensus.
• Ability to make effective oral presentations and prepare concise written reports to a variety of audiences.
• Ability to plan, organize, prioritize, work independently and meet deadlines.
• Knowledge of computer systems and software used in functional area.
• Knowledge of local, state and federal regulatory requirements related to areas of functional responsibility.
• Demonstrated knowledge of CPT, HCPCS and ICD-10 codes and rules.
• Ability to establish and maintain collaborative effective working relationships.
• Ability to bring together multi-disciplinary teams to seek consensus and value problem.

Licenses and Certifications

• Certified Professional Medical Auditor (AAPC-CPMA) and
• CRC - Certified Risk Adjustment Coder and
• CPC - Certified Professional Coder or
• CCS - Certified Coding Specialist

Physical Demands and Work Conditions

Physical Demands

• Constant Sitting.
• Frequent Walking.
• Occasional Standing.
• Occasional Bending.
• Occasional Squatting.
• Occasional Climbing.
• Occasional Kneeling.
• Seldom Crawling.
• Constant Hand Use.
• Constant Repetitive Motion Hand Use.
• Frequent Grasping.
• Occasional Fine Manipulation.
• Frequent Pushing and Pulling.
• Occasional Reaching (above shoulder level).
• Frequent Twisting and Turning (Neck and Waist).
• Constant Vision (Color, Peripheral, Distance, Focus).

Lifting

• Frequent lifting of 0 - 10 lbs.
• Occasional lifting of 11 - 20 lbs.
• Seldom lifting of 21 - 30 lbs.
• Seldom lifting of 31 - 40 lbs.
• Seldom lifting of 40+ lbs.

Carrying

• Frequent lifting of 0 - 10 lbs.
• Occasional lifting of 11 - 20 lbs.
• Seldom lifting of 21 - 30 lbs.
• Seldom lifting of 31 - 40 lbs.
• Seldom lifting of 40+ lbs.

Working Environment

• Occasional Driving cars, trucks, forklifts and other equipment. May be required to drive personal vehicle to sites.
• Constant Working around equipment and machinery. Office equipment (computers, phones, fax, copy machines, printers, 10-key, etc.).
• Seldom Walking on uneven ground.
• Seldom Exposure to excessive noise.
• Seldom Exposure to extremes in temperature, humidity or wetness.
• Seldom Exposure to dust, gas, fumes or chemicals.
• Seldom Working at heights.
• Seldom Operation of foot controls or repetitive foot movement.
• Seldom Use of special visual or auditory protective equipment.
• Seldom Use of respirator.
• Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc..
• Seldom Other (please list each item under Comments):.

Blood Borne Pathogens

• Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

Travel Requirements

• 10% travel:

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Pay: $44.13 - $57.36 per hour

Benefits:

• 401(k)
• 401(k) matching
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Retirement plan
• Tuition reimbursement

Education:

• High school or equivalent (Required)

Experience:

• Healthcare setting with billing, coding, risk adjustment: 4 years (Required)
• EMR-based multi-specialty physician coding : 5 years (Preferred)

License/Certification:

• AAPC-CPMA - Certified Professional Medical Auditor (Required)
• CRC - Certified Risk Adjustment Coder (Required)
• CPC - Certified Professional Coder (Preferred)
• CCS - Certified Coding Specialist (Preferred)

Work Location: Hybrid remote in Newark, CA 94560